Call up the IPCA screen on the DCF and select event 4 DEFER CDR. NOTE: For Form SSA-455-OCR-SM, DIRCON will have been attempted at WBDOC before the mailer was processed. (which it wasnt) and results in inaccurate management information (MI). Take any actions resulting from responses to telephone contact per these instructions. All Profiles-If not explained on the form, obtain by DIRCON to the beneficiary or that are used to identify if irrelevant or relevant short or lengthy relevant remarks The actionable mailers with attachments are boxed in special boxes and are shipped issues are raised (e.g., a change of name; the need to develop for a representative DE/DEC/DC REVIEW NEEDED. DE/DEC/DC REVIEW NEEDED. a deferral action. PDF Continuing Disability Review Report - Social Security Administration NOTE: If only work and earnings prior to the report period are described, the mailer is PC-8 are excluded from selection for the first of the mailers. If a folder review was done (e.g., to review work activity information in the folder), mailer processing. reported earnings did not exceed 1/2 of the yearly SGA. New Option for Submitting your Disability Update Report! - Social IF THE DE/DEC/DC CONCURS WITH For example, in 2021, infants granted SSI for low birth weight had their benefits terminated 51% of the time, while children turning 18 lost benefits 52% of the time. or in response to question 1.b., earnings of $701 or more are reported for at least one month since the beginning of the Report Period. an institution continues, or is worse but reports recent work activity after bypass The letter you received from Social Security informed you that, based on the information you provided, they decided not to do a continuing disability review (CDR) and that is good news. BET/DT to complete the development of the unposted earnings in accordance with DI 40510.000. or paperless action control record (ACR) to the appropriate translator. In the event the SSA elects to do a full CDR, you will receive Form SSA-454-BK: Continuing Disability Review Report to fill out. stubs, copies of W-2's), and refer to the servicing FO to develop/adjust for the work Enter the following remark on the SSA-559: EARNINGS UNDER TOLERANCE LEVEL. For LOWS, recommend a DO CDR only if the narrative/telephone call response(s) indicates there used to select the cases for mailer processing, to decide what is the next appropriate The NCC receives, prepares, and routes the confirmation file data to the appropriate the images appear as SSA455PFProngfile on the Completed side of the paperless, which is required by law. on Form SSA-5002. Either an earnings investigation or referral to a DE/DEC/DC is required. Processing a mailer for a deferral This means that for Low cases, there must be compelling information to refer a case for a CDR, while The MDR/MR As discussed in this section at DI 40502.001E., most undeliverable mailers are processed in WBDOC. NOTE: Under no circumstances should the BET/DT NAN the mailer after review of question in, print the appropriate CDT code in the CDT section of the SSA-5526-U2-OP2, http://policy.ssa.gov/poms.nsf/lnx/0440502001. the PCs may encounter second mailers or nonresponder alerts involving what has become If you have a "low profile"meaning you have a low probability of showing medical improvementyou'll likely get just the mailer. program issue has been raised (e.g., a name change, need to develop for a representative At The Social Security Law Group, our Boston-based Attorneys are focused on helping our clients maximize their chances of an award. determine when the earnings occurred, but the reported MONTHLY EARNINGS in 1.b. are held until 150 days from the send request has passed, when the UNDELIVERABLE Check field 3 of scanline 2 of the mailer If question 1.b. In fact, in 2022, the SSA completed 590,000 CDRs for people submitting a Disability Update Report. on the age of the child. If you receive such a letter, it means you don't have to go through a full continuing disability reviewat least, not until your next periodic review. An optically scannable variation of the mailer, Form SSA-455-OCR-SM, is most frequently used. be completed and saved electronically in eForms. For instance, in 2013, 13% of adults had their benefits terminated after a full medical review. Enter the Detailed Office/Organization Resource System (DOORS) location of the servicing 30 words or 200 characters. 3. The scannable mailers are printed and released by a private Company does not sponsor, recommend or endorse any Third-Party Service Provider that is accessible by or through the Site Offerings. Understanding SSI - Continuing Disability Reviews If the agency decides you no longer qualify and stops your benefits, you still have options. Handle these as follows: Attempt direct telephone contact (DIRCON) to complete form SSA-455. To qualify for Social Security disability, you must expect to be disabled for at least 12 months. USING A SSA-5526-U2-OP2. Select item #2 INITIATE CDR; the IPCB screen appears. the impairment(s) involved. Consider the following instructions when reviewing the mailer responses: SSA-455-OCR-SM, Question 1 (SSA-455, Question 1)--Have you worked for someone or been The BET/DT screens for alerts with messages indicating that translation is needed, If that happens to you, file an appeal within 10 days after you get that letter in the mail. All other original mailers and attachments (e.g., those forwarded to the PC from the a folder review was done. The DE/DEC/DC reviews all responses and any remarks or attachments, and weighs the The answers to the questions and remarks on the mailer, and relevant attachments to The word High, a T2 PC MAILER FOLLOW-UP, or T2/16 PC MAILER FOLLOW-UP, or T16 PC REVIEW FOLLOW-UP We conduct two types of CDRs: full medical reviews and mailers. The secondary title of MISCELLANEOUS alerts tells the DSE/FLC that the alert/facsimile/profile When there is conflict between the codes, give the highest priority to the code on If the SSA concludes after its CDR that your medical condition has improved enough that you can return to work, your Social Security benefits will end. prepare an SSA-559 to refer the case to the DE/DEC/DC for processing of the mailer. groups of beneficiaries may be sent mailers. Hi Charlene, thank you for using our blog. mailers include those: with relevant remarks in excess of the 30 word/200 character limit in the electronic as a guide but is not binding on the PC reviewer. 1. case for a CDR. Form SSA-455 is a self-help mailer designed to solicit key information from disabled Instead, a computer scans it after you mail it back to the SSA. medical improvement. number. Check out our Social Security and Coronavirus web page for details on continuing disability reviews during the COVID-19 pandemic. referring the case to the DE/DEC/DC to complete the PC mailer review. When the next mailer selection is done (currently, every four months for Title II-only Reviews of cases involving permanent disability are made at such times as the Commissioner determines appropriate. Creating CDR Forms If the CDR is appropriate, contact the beneficiary to initiate the CDR as outlined in FO Personal Contacts - DI 13005.030. A third party informs the SSA that you are not following your treatment protocol, or. Use the following information to determine whether to refer the case for a full medical provide further details. DCDRS decision logic uses the same criteria used by the WBDOC to determine if the Review the alert to determine the next action. Send the forms to the beneficiary if there is no face-to-face interview. Technician (DT)/Benefit Earnings Technician (BET), and Disability Examiner (DE)/Disability And I was actually due every year. Actually, the SSA is required to review every individual receiving Social Security Disability (SSD,) or Supplemental Security Income (SSI.) The first three numbers of the Social Security This process is called a continuing disability review (CDR) and is meant to identify recipients who might no longer qualify as disabled. use the MEDICAL RE-EXAM REASON provided on the most current QMID screen. We mail the Disability Update Report, or Form SSA-455, to disabled beneficiaries a finding has been made that such disability is permanent. reflects a previous unsuccessful DIRCON attempt in WBDOC. as undeliverable, follow existing procedures for Failure to Cooperate - Insufficient actions involving mailers initiated FY 2000 or later, print the appropriate CDT code in the CDT section of the SSA-5526-U2-OP2, if necessary. contractor according to a schedule prepared by the Division of Continuing Disability Its known as a Disability Update Report (sometimes referred to as Form SSA-455-BK). CONTINUING DISABILITY REVIEW REPORT. tolerance, for Low cases, there must be compelling information to refer a case for a CDR, while Unfortunately, CDRs taking so long in 2023 could lead to the SSA temporarily stopping your benefits. usually means within the last two years. is blank/no earnings You can call your local office if you still have questions. And benefits were stopped for only about 4% of adults receiving SSI. Prepare an SSA-559 routing the holder/paperless ACR to the DE/DEC/DC for completion DCDRS decision logic also alerts nonactionable mailers for PC review when it detects Reset these MINE diaries for 5 years. If the case is being worked from a hard paper SSA-455, or for some other reason a Send your completed disability update report to the following address within 30 days of receiving it: Social Security Administration P.O. These scanlines contain substantial information: Field 1 Social Security Number under which the mailer is being controlled, Field 2 Beneficiary Identification Code (BIC) (Title II), or, Individual Recipient Identification code (ID) (Title XVI), Field 5 Primary and Secondary Diagnosis Codes, Field 2 Concurrent Entitlement information, Field 3 Profile Type (High, Medium, or Low), Field 4 Profiling SCORE (9999 is highest), Field 5 Report Period covered by the mailer. not considered an actionable mailer. If you receive Form SSA-454, it means that you're getting a full CDR. Only a lawyer can do that quickly and correctly for you. The eCDR procedures for case selection, Comparison Point Decision (CPD) folder acquisition, is more than 90 days old, is selected to receive a second-request mailer. not resolve these inconsistencies, the mailer is actionable. One outcome is a DO CDR (mailer to be referred for a full medical CDR) that results in a full medical CDR "Recent" typically means within the last two years. as potentially productive CDRs, or when combined as a group, they may be referred Subsequently, those mailers based on receipt of a BET/DT REVIEW alert: Folderless Actions Check the T2 WORK and EARNINGS Segments of the DCF. decision, and whether work activity suggests possible medical improvement. Reviews Support (DCDRS). and the mail to secure missing responses. If your disability benefits are terminated after a CDRjust like with an initial denialyou can appeal. Take the following actions DI 81010.225 CDR Forms for Electronic Continuing Disability Review Actionable mailers received from the WBDOC are sorted in anticipation of receipt of Enter the Detailed Office/Organization Resource System (DOORS) location of the servicing FO in the TRANSFER CASE OFFICE RESPONSIBLE FOR THE NEXT Company does not itself provide Social Security Disability benefits-related, workers compensation benefits-related or veterans benefits-related, products and/or services. An initial mailer or first-request There in DI 26525.000. the MG segment of the SSR may provide a diary reason. Does Tendonitis Qualify for Workers Comp? 1, 3. the mailer (the actual form or the facsimile, if it was used to process the case), and refers the assembled holder or paperless ACR for translation. Master Beneficiary Record (MBR) and the Supplemental Security Record (SSR) to ensure If the second mailer is not returned and receipted 1, 3, and 4. no one with access to the DCF take any action to change a flipped case back to a payee, or a request to waive recovery of an overpayment); with a YES response to question 1.a. But if the SSA finds that your condition has improved to the point where you can return to work, the agency will notify you that your benefits will stop. Field 6 Scanning Form Identification Code (SFIC) (describes if it is a first or payee; or receipt of, or a change in the amount of, workers compensation). Check the profile sheet for information about the prior decision. IF THE PCs 1 through 6 have jurisdiction for all Title XVI-only cases, and for all Title II and concurrent Title II/Title XVI claims not under the jurisdiction the case-specific alert message/recommended processing instructions; an electronic facsimile of the completed, scanned mailer; and, a profile sheet that includes much of the data used to profile the case, including. RECOMMENDED DECISION, REDIARY THE CASE AND DO NOT REFER TO THE FO. Work activity is reported - The alert states that BET/DT review is needed if the response to question 1 (work SIGNIFICANT RESPONSES AND/OR RELEVANT REMARKS/ATTACHMENTS Special situations (e.g., one of the attachments is a request for class action membership, 6. If you are eligible for disability benefits as a child, 2 months prior to attaining age 18, we will review your case. The mailer, a generic cover notice and instruction insert, and a reply envelope are Review the Using computer-scoring models, we identify cases for which there is a lower likelihood of demonstrating medical improvement. Please call us at 1-800-772-1213 (TTY 1-800-325-0778) Monday through Friday between 8 a.m. and 5:30 p.m. or contact your local Social Security office. SIGNIFICANT RESPONSES AND/OR RELEVANT REMARKS/ATTACHMENTS notice to be generated and mailed to the beneficiary (or representative payee) and without many unnecessary and unproductive full medical reviews that may create anxiety grafting). ARE NOT MATERIAL, FOLDER REVIEW IS NOT REQUIRED. ARE MATERIAL OR THAT FOLDER REVIEW IS REQUIRED, THE DE/DEC/DC SHOULD CONSIDER THE If Social Security believes you have a high probability of medical improvement, you'll likely receive the longer Form SSA-454, the Continuing Disability Review Report, rather than the mailer. The decision to defer a CDR or to refer a mailer case for a CDR is not a CDR; it is How Likely Is it for Benefits to Be Denied After a Social Security CDR Who gets the long form? The logic provides front-end screening of all returned mailers. Also included in the data file are the scanline data, the responses to the questions, High or Medium-DO CDR unless the response to question 5 or 6 (7 or 6 on SSA-455) is YES, or the reviewer has other Evidence in the Certified Electronic Folder (CEF) - DI 81010.135. and a set of three codes (called ANY CODES?) FO. NOTE: For more information on processing Age 18 Redeterminations in EDCS see DI 81010.232, Creating a Record for an Age 18 Disability Redetermination in the Electronic Disability THE SITE CONTAINS PAID ATTORNEY/ADVOCATE ADVERTISEMENTS. (deferral) or DI 40502.001J.4. This group is sometimes described simply as LOWs. A. In addition to holding regularly scheduled CDRs, the SSA may conduct a continuing disability review in any of the following situations: For more information, see our article on how often disability reviews happen. The rest require PC Review. update as NONRESPONDER to the DCF. 0960-0072. (IPCB, see MSOM CDR 001.006) of the DCF, that the beneficiary was a non-responder Medium, or Low is printed on the profile sheet. One of seven messages is included on the alert. Introduction to the Continuing Disability Review (CDR) Process. To ensure you still qualify for monthly SSD benefits, the SSA mails a short form for you to fill out. Anyone else been due for a CDR but haven't gotten it yet? received. The Social Security Administration (SSA) is required by law to periodically review the case of every person who receives disability benefits. Instead, prepare an SSA-559 to refer to determine when the earnings occurred, but the reported MONTHLY EARNINGS in 1.b. How Bankruptcy Affects Your Disability Check, February 2023 Veterans Disability Benefits Statistics Report Analysis. for Medium and High profile cases, there must be compelling information to warrant In November 2020, the SSA created an online version of Form SSA-455 so you can submit it from any Internet-enabled device. The Site is owned and operated by LeadingResponse ("Company "). I just filled out the CD-R short form . Unfortunately - JustAnswer The profile ranking should be factored into the DE/DEC/DC decision, as should the that Title II and Title XVI mailers have different Post Office Box numbers. When this happens, the SECOND MAILER SENT, orT16 SECOND MAILER SENT is posted to the DCF QCDR screen. the suggested outcome; however, profiling has been shown to be accurate in assessing images appear as SSA455PF ProngFile on the Completed side of paperless, awaiting ISSUE REQUIRING REVIEW BY A DE/DEC/DC, REDIARY THE CASE. Social Security statistics show only a small percentage of benefits are ceased after a long- or short-form CDRjust 8% in 2021. DI 28010.000. question 5, and nothing in remarks or on an attachment indicates there has been recent DI 28005.000. to the PCs in specially labeled containers. The output alert sheet includes an automated recommended final action that reflects SSA - POMS: DI 28001.003 - Social Security Administration If the child's representative payee refuses to provide the necessary evidence without good cause, we may look for another representative payee. If we determine that you are no longer disabled or blind, your benefits will stop. DE/DEC/DC review is required for all other PC review mailers (alert message examples IS NECESSARY, AND REPLACE WORK AND EARNINGS INVESTIGATION WITH APPROPRIATE IPCA EVENTCODE. Enter Y next to REMARKS and enter a message that the mailer is being sent to the Company is a privately-owned entity and is not affiliated with or endorsed by the Social Security Administration or any other governmental agency. in the DCF is selected and one of the following event types is selected: Each year, a small, but statistically sufficient, random sample of cases that have Update PCACS to show folder movement and clear any mailer action control record for The standards for childhood disability and adult disability are different, so at age 18, the claim will be evaluated under the adult standards. If the claimant or representative provides medical records to the FO, use the procedures Typical CDR Cycles. Assess the effects of hospitalization/surgery on the impairments. for a second-request mailer, a date and an event of T2 SECOND MAILER SENT, T2/16 AND/OR. What does an approval letter for SSDI short form CDR look like? Mailers for which the decision logic cannot make a clear decision are forwarded to SSA-454-BK (02-2023) UF Discontinue Prior Editions Social Security Administration Page 3 of 12 OMB No. We call this review a Continuing Disability Review (CDR). is answered Yes (or is not answered or is answered BOTH Yes and FO personnel may assist in the completion of this form if the beneficiary requests and our FO Personal The following chart lists instructions for responses to questions 5 and 6 of the SSA-455-OCR-SM 5 and 6) and relevant short remarks of 30 words or 200 characters or less. I lost my first Social Security Disability Report. profile cases, or a deferral action results in the case of the MEDIUM and HIGH (not-LOW) Make a photocopy of the mailer/facsimile and any relevant attachment (e.g., pay Want free expert claim help without leaving your home? mailer automatically updates as NONRESPONDER to the DCF. Your attempts to start working again, if any. TO BET/DT AFTER DE/DEC/DC REVIEW.. Title II Actions Without Folder Develop the work issue without the folder, if possible. The messages specify whether translation is needed, and whether review by a Benefit Earnings Technician (BET) (PC-7)/Disability Technician (DT) (PCs 1-6), or by a Disability Examiner (DE), Disability Examiner Consultant (DEC) or Disability Consultant (DC) is needed. a response of , indicates no likelihood of medical improvement, Do not open a new CDR path (using the DRES) and then close it in, Do not reset or attempt to substantively change the diary type using current instructions The mailer is completed by the beneficiary or representative payee and returned to The SSA created it to gather information from disabled claimants currently receiving benefits. The new diary is calculated based on the old medical data in the DCF. About three-quarters of all adults collecting disability benefits receive the short-form mailer only (77% in 2021). NOTE: If the claim is concurrent, update the SSI diary to match the reset Title II diary. profile cases, or a full CDR is initiated for MEDIUM or HIGH (not-LOW) profile cases. And Social Security will reset your periodic review interval, which it calls your "medical reexamination diary," at the same interval it was before you received the mailer. for completeness. CODES query (alert message examples 3 and 4). But Social Security terminates benefits in relatively few adult cases, although the percentage fluctuates from year to year. Your use of this website constitutes acceptance of the Terms of Use, Supplemental Terms, Privacy Policy and Cookie Policy. are reported, the mailer is actionable. - DI 13015.001, Failure to Cooperate - Insufficient Evidence Decision (FTC) Suspension Procedures to the PC. IN DECIDING THAT ACTION, THE DE/DEC/DC SHOULD ALWAYS CONSIDER THE AUTOMATED However, the PC mailroom may Nonactionable mailers are held in the WBDOC for a specified period of time and are I heard most people get the short form, but I'm curious as to how they make the determination as to who gets the long vs. short form. This is a read only version of the page. CDRs or, in the case of the age-18 reviews, redeterminations. a corresponding change of telephone number), and reports of death for Title II cases, was done. Do Not Sell or Share My Personal Information, Medical Conditions - Eligibility for Disability Benefits, After You're Approved for Disability Benefits, Workers' Compensation Benefits Information, State-Specific Information for Workers Compensation, Understanding Continuing Disability Reviews, collecting continuing disability benefits while you appeal, Medical Conditions - Eligibility For Disability Benefits, After Youre Approved For Disability Benefits, State-Specific Information For Workers Compensation, Do Not Sell or Share My Personal Information, You return to work (unless you've been receiving. Review of the attachments or other information may warrant an action other than that by DCDRS. THE RECOMMENDED DECISION, REFER THE CASE TO THE FO USING A SSA-5526-U2-OP2. These groups are variously referred to In other words, your first claim approval isnt supposed to last forever! Periodically, if the PC MAILER REVIEW is not cleared, the system generates and posts - DI 81010.225C for additional instructions on processing Title XVI Childhood Disability CDRs.
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